苏州市非因公劳动能力鉴定申请表

1、苏病鉴申字第 号苏州市职工非因工伤病劳动能力鉴定申请表伤病职工：申请单位（单位公章：）单位地址:邮政编码:单位联系电话:单位联系人:填表日期:苏州市人力资源和社会保障局受理编号:被鉴定人 姓名性口力出生年月近期照片身份证 号码社保编号参加工作 时间伤病前工种伤病发生 时间联系电话原鉴定时 间及等级伤病 情 况职工本人签字鉴护人签字市（区）劳动 保障部门意见年月日（公章）劳动鉴定申报附以下材料：1申请人因病鉴定申请书2职工身份证复印件；3伤残职工完整连续的原始病历、诊断结论等有关材料复印件；4精神病人申报劳动能力鉴定时需经鉴护人签字确认；5职工供养直系亲属劳动能力鉴定，需提供被鉴定人与职工之间直

2、系亲属关系的有关证明材料。 说明：1.此表填一份，请按表式要求填写；2.劳动能力鉴定收费标准每人次280元；3地址：体育场路 4号1号楼101联系电话学分科类别：简要病情及治疗经过:医疗检查和鉴定情况:劳动功能障碍程度：残情参照鉴定标准级条，拟定级医师（签章）：鉴定结论:根据职工非因工伤残或因病丧失劳动能力程度鉴定标准、劳动能力鉴定 职工工 伤与职业病致残等级，苏州市劳动能力鉴定委员会作出如下鉴定结论:1. 病残程度为级2.苏州市劳动能力鉴定委员会章Whe n you are old and grey and full of sleep,And nodding b

3、y the fire, take dow n this book,And slowly read, and dream of the soft lookYour eyes had once, and of their shadows deep;How many loved your mome nts of glad grace,And loved your beauty with love false or true,But one man loved the pilgrim soul in you,And loved the sorrows of your cha nging face;An

4、d bending dow n beside the glow ing bars,Murmur, a little sadly, how love fledAnd paced upon the mountains overheadAnd hid his face amid a crowd of stars.The furthest dista nee in the worldIs not betwee n life and deathBut whe n I sta nd in front of youYet you don't know thatI love you.The furth

5、est dista nee in the worldIs not whe n I sta nd in front of youYet you can't see my loveBut whe n un doubtedly knowing the love from bothYet cannot be together.The furthest dista nee in the worldIs not being apart while being in loveBut whe n I pla inly cannot resist the year ningYet prete nding you have n ever bee n in my heart.The furthest dista nee in the worldIs not struggli ng aga inst the tidesBut using